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Women Underrepresented in Academic Oncology Program Leadership

Results of a cross-sectional study of accredited US medical oncology, radiation oncology, and surgical oncology training programs reveal that women are markedly underrepresented in academic leadership positions across the oncology disciplines.

"As women constitute half of the US population, and cancer is the second leading cause of death for men and women, promoting a more gender-balanced workforce more representative of its patient population is critical," write the investigators of the study published today in JAMA Network Open, led by first author Mudit Chowdhary, MD, Chief Resident of Radiation Oncology at Rush University Medical Center.

The study authors queried training program websites from October 2018 through June 2019. All faculty members from 265 of the 273 accredited programs (97.1% of the programs) in medical oncology, radiation oncology, and surgical oncology were included in the analysis, for a total of 6,030 faculty members. Of these, only 2,164 (35.9%) were women. Women comprised 37.1% of medical oncology faculty, 30.7% of radiation oncology faculty, and 38.8% of surgical oncology faculty. Representation was substantially lower among department chairs, with 21.7% of medical oncology programs (30 of 138 programs), 11.7% of radiation oncology programs (11 of 94), and a mere 3.8% of surgical oncology programs (1 of 26) chaired by women. Overall, 47.9% of medical oncology programs, 33% of radiation oncology programs, and 18.5% of surgical oncology programs had at least one woman in a leadership position, as either program director or chair.

For the first time in 2017, more women were enrolled in US medical schools than were men. Women are still underrepresented in medical oncology and radiation oncology training programs, although the gap seems to be lessening in medical oncology. It has previously been found that women remain underrepresented in academic medicine and in medical leadership positions, but prior to this study, women's level of representation in oncology academic leadership positions was unknown.

Among medical oncology and radiation oncology programs, having at least one woman in a leadership position was associated with a higher mean percentage of women faculty (40.7% vs 33.1% for medical oncology and 36.2% vs 23.4% for radiation oncology). Among surgical oncology programs, the association tended in the same direction (40.2% vs 31.4%) but lacked statistical significance.

"Interestingly, surgical oncology demonstrated the highest rate of overall women faculty but the lowest rates of women in leadership both overall and when restricted to the chair position, relative to medical oncology and radiation oncology," write Dr. Chowdhary and colleagues. "Unlike medical oncology and radiation oncology, there was no association between having a woman chair with higher rates of total women faculty, although this is most likely due to low power."

"These findings are consistent with previous studies showing that women hold only a small minority of other visible and influential positions in medicine, such as authorship, leadership of medical specialty societies, and editorial board membership. A common metaphor for describing the diminishing proportion of women observed at each level of leadership has been that of a pipeline," write Laila A. Gharzai, MD, LLM, a fourth-year radiation oncology resident, and Reshma Jagsi, MD, DPhil, Deputy Chair of Radiation Oncology, both of Michigan Medicine, in a commentary published alongside the study in JAMA Network Open. "Some believe the pipeline is simply long: progress is slow owing to the sheer length of the path to senior positions and the lag time before the people who compose the overwhelmingly male older cohorts retire. If the pipeline were simply slow, representation of women would increase initially in the early ranks and then later in more senior positions... Despite near-parity in medical schools for decades, this has simply not materialized, raising concerns that the pipeline is not simply long but also leaky, with women dropping out of the pathway that leads to leadership in the field owing to gender-specific challenges."

"Oncologists must encourage our profession to begin the process of cultural transformation necessary to improve equity and bring more women into leadership positions," conclude Dr. Gharzai and Dr. Jagsi. "We owe it to each other, to the women in our field who will come after us, and to our patients—it is time to fix that broken pipeline."

For More Information

Chowdhary M, Chowdhary A, Royce TJ, et al (2020). Women's representation in leadership positions in academic medical oncology, radiation oncology, and surgical oncology programs. JAMA Netw Open. [Epub ahead of print] DOI:10.1001/jamanetworkopen.2020.0708

Gharzai LA & Jagsi R (2020). Ongoing gender inequity in leadership positions of academic oncology programs: the broken pipeline. JAMA Netw Open. [Epub ahead of print] DOI:10.1001/jamanetworkopen.2020.0691

Image courtesy of the National Cancer Institute

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